Public health surveillance is the cornerstone of all public health activities, and essential public health[unreadable] services include monitoring health status to identify and solve community health problems, and diagnosing[unreadable] and investigating health problems in the community. Progress towards interoperable electronic health[unreadable] records and regional health information exchange initiatives offers the promise of much higher quality clinical[unreadable] data for surveillance purposes.[unreadable] Our overall goal is to develop and demonstrate electronic health information exchange from clinical[unreadable] information systems that improves public health surveillance of emerging health issues.[unreadable] We plan to test the following hypotheses:[unreadable] (1) Routine reporting of antibiotic resistance data through the Electronic Clinical Laboratory Reporting[unreadable] infrastructure is feasible, acceptable, and useful for public health surveillance. To test this hypothesis, we[unreadable] plan to initiate secure, standards-based electronic reporting of antibiotic resistance testing data from multiple[unreadable] clinical laboratories within NYC and to create community-wide outpatient antibiograms.[unreadable] (2) Electronic health records contain structured and unstructured data that can provide specific, actionable[unreadable] information for real-time public health surveillance purposes. To test this hypotheses, we plan to examine the[unreadable] performance characteristics of ambulatory electronic health record (EHR) data elements for syndromic case[unreadable] and outbreak detection, employing natural language processing for the unstructured elements.